1
|
Gad AM, Zawam SH. Arthroscopic biceps tenodesis using press-fit bony plug: a case series study. Int Orthop 2024; 48:785-792. [PMID: 37924503 PMCID: PMC10902084 DOI: 10.1007/s00264-023-06021-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE To assess the feasibility, operative time, clinical outcomes, possible complications, and failure rates of all-through arthroscopic biceps tenodesis using press-fit bony plug technique. METHODS This prospective case series study involved 30 skeletally mature patients with long head of biceps pathology (tendinitis after failure of conservative treatment, subluxation, dislocation, or tendon tears). All patients were followed up for 24 months at least. RESULTS Twenty-nine patients regained full shoulder and elbow range of motion; one case suffered from reflex sympathetic dystrophy. There was a significant improvement in the constant, ASES, and VAS scores when comparing the pre-operative and post-operative values. The average biceps strength was 96% compared to the opposite healthy side. No cases were complicated by neuro-vascular deficits or failure of the tenodesis. CONCLUSION Press-fit biceps tenodesis is safe and accessible with low economic demands. We recommend this technique to be used more often when addressing patients with long head of biceps pathologies. REGISTRATION DATA Registration number: N-1562023. Registration date: June 2022 "Retrospectively registered".
Collapse
Affiliation(s)
- Ahmed Mahmoud Gad
- Department of Trauma and Orthopedics, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Sherif Hamdy Zawam
- Department of Trauma and Orthopedics, Faculty of Medicine, Cairo University, Giza, Egypt.
| |
Collapse
|
2
|
Ni M, Gao L, Chen W, Zhao Q, Zhao Y, Jiang C, Yuan H. Preliminary exploration of deep learning-assisted recognition of superior labrum anterior and posterior lesions in shoulder MR arthrography. Int Orthop 2024; 48:183-191. [PMID: 37726561 PMCID: PMC10766676 DOI: 10.1007/s00264-023-05987-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/11/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE MR arthrography (MRA) is the most accurate method for preoperatively diagnosing superior labrum anterior-posterior (SLAP) lesions, but diagnostic results can vary considerably due to factors such as experience. In this study, deep learning was used to facilitate the preliminary identification of SLAP lesions and compared with radiologists of different seniority. METHODS MRA data from 636 patients were retrospectively collected, and all patients were classified as having/not having SLAP lesions according to shoulder arthroscopy. The SLAP-Net model was built and tested on 514 patients (dataset 1) and independently tested on data from two other MRI devices (122 patients, dataset 2). Manual diagnosis was performed by three radiologists with different seniority levels and compared with SLAP-Net outputs. Model performance was evaluated by the receiver operating characteristic (ROC) curve, area under the ROC curve (AUC), etc. McNemar's test was used to compare performance among models and between radiologists' models. The intraclass correlation coefficient (ICC) was used to assess the radiologists' reliability. p < 0.05 was considered statistically significant. RESULTS SLAP-Net had AUC = 0.98 and accuracy = 0.96 for classification in dataset 1 and AUC = 0.92 and accuracy = 0.85 in dataset 2. In dataset 1, SLAP-Net had diagnostic performance similar to that of senior radiologists (p = 0.055) but higher than that of early- and mid-career radiologists (p = 0.025 and 0.011). In dataset 2, SLAP-Net had similar diagnostic performance to radiologists of all three seniority levels (p = 0.468, 0.289, and 0.495, respectively). CONCLUSIONS Deep learning can be used to identify SLAP lesions upon initial MR arthrography examination. SLAP-Net performs comparably to senior radiologists.
Collapse
Affiliation(s)
- Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Lixiang Gao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Wen Chen
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Qiang Zhao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Yuqing Zhao
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Chenyu Jiang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China.
| |
Collapse
|
3
|
Nunna B, Parihar P, Wanjari M, Shetty N, Bora N. High-Resolution Imaging Insights into Shoulder Joint Pain: A Comprehensive Review of Ultrasound and Magnetic Resonance Imaging (MRI). Cureus 2023; 15:e48974. [PMID: 38111406 PMCID: PMC10725840 DOI: 10.7759/cureus.48974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/17/2023] [Indexed: 12/20/2023] Open
Abstract
Shoulder joint pain is a complex and prevalent clinical concern affecting individuals across various ages and lifestyles. This review delves into the pivotal role of high-resolution imaging techniques, namely ultrasound and magnetic resonance imaging (MRI), in the comprehensive assessment and management of shoulder joint pain. We explore the anatomical foundations of the shoulder, common etiologies of pain, and the significance of precise diagnosis. High-resolution imaging facilitates the identification of various shoulder pathologies and is crucial in treatment planning, surgical interventions, and long-term prognosis assessment. We examine emerging technologies, discuss challenges and limitations, and chart potential future developments, emphasizing the ongoing evolution of imaging in this critical healthcare domain. In conclusion, high-resolution imaging is an indispensable tool, continually advancing to meet the diagnostic and therapeutic needs of individuals grappling with shoulder joint pain.
Collapse
Affiliation(s)
- Bhagyasri Nunna
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Pratap Parihar
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Neha Shetty
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Nikita Bora
- Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| |
Collapse
|
4
|
Çetinkaya M, Kaptan AY, Ulucaköy C, Orhan Ö, Topal M, Ayanoğlu T, Kanatlı U. Is it the subcoracoid impingement or the subacromial impingement that tears the subscapularis tendon? A comparison of the MRI findings of the operated and healthy shoulders of the patients. Turk J Med Sci 2023; 53:273-281. [PMID: 36945924 PMCID: PMC10387881 DOI: 10.55730/1300-0144.5582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/22/2022] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND : The purpose of this study is to investigate whether the etiological factors accepted as causes of idiopathic subscapularis tears are true or not when the comparison is made with the opposite side healthy shoulder of the patients who underwent arthroscopic repair for an isolated subscapularis tear. METHODS Sixteen patients who underwent shoulder arthroscopy between February 2016 and January 2018 and were diagnosed with isolated subscapularis tear were evaluated. The coracohumeral distance (CHDax), coracoid overlap (CO), and tuberculum minus cysts (TMC) were evaluated on the axial images of the MRI studies while the acromiohumeral distance (AHDsag), CHDsag, and subscapularis tendon slip number (STSN) on the sagittal oblique images and the AHDcor and SLAP lesion on the coronal oblique images. Degeneration of the coracoacromial ligament was evaluated during arthroscopy. RESULTS The mean CHDsag (11.26-10.08), CHDax (10.63-9.98), CO (14.2-15.43), AHDsag (8-7.66), and AHDcor (7.65-7.68) measurements (operated side-healthy side, respectively) were statistically similar (p > 0.05). No statistically significant difference was found between TMC and STSN in healthy and operated shoulders (p > 0.05). There was mild coracoacromial ligament fraying in 4 (25%) and obvious coracoacromial ligament fraying in 8 (50%) which indicated subacromial impingement in 75% of the patients. DISCUSSION The parameters of the coracoid process did not reveal any significant difference between the operated (for an isolated subscapularis tear) and opposite-side healthy shoulders of the patients. However, coracoacromial ligament degeneration was present in 75% of the patients.
Collapse
Affiliation(s)
- Mehmet Çetinkaya
- Department of Orthopaedics and Traumatology, Başakşehir Çam ve Sakura City Hospital, İstanbul, Turkey
| | - Ahmet Yiğit Kaptan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Coşkun Ulucaköy
- Department of Orthopaedics and Traumatology, Dr. Abdurrahman Yurtaslan Onkoloji Training and Research Hospital, Ankara, Turkey
| | - Özlem Orhan
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Harran University, Şanlıurfa, Turkey
| | - Murat Topal
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey
| | - Tacettin Ayanoğlu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Abant İzzet Baysal University, Bolu, Turkey
| | - Ulunay Kanatlı
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
5
|
Yıldız V, Özgezmez FT. Arthroscopic evaluation of failed primary type II SLAP lesion repair in patients with high physical activity over 40 years of age and the outcomes of tenotomy. Jt Dis Relat Surg 2021; 32:649-657. [PMID: 34842097 PMCID: PMC8650674 DOI: 10.52312/jdrs.2021.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives
In this study, we aimed to examine patients over 40 years of age who underwent failed primary isolated type 2 superior labrum anterior posterior (SLAP) repair arthroscopically and to evaluate the outcomes of tenotomy. Patients and methods
Between March 2011 and December 2019, a total of 32 patients (19 males, 13 females; median age: 55.1 years; range, 41 to 59 years) who underwent primary repair for SLAP due to high activity levels and in whom the treatment failed were retrospectively analyzed. Biceps tenotomy was applied to all patients. The Constant-Murley Score (CMS), Visual Analog Scale (VAS) pain scores, and muscle strength before and after re-arthroscopy were compared. Results
The median follow-up time was 27 (9-84) months after biceps tenotomy. During arthroscopy, failure was detected in three (9.37%) patients and additional pathologies were detected in five (15.62%) patients. Patients with biceps tenosynovitis were 29 (90.62%). The mean pre- and postoperative CMS scores were 40.5±11.1 and 86.3±8.1, respectively (p<0.001). The mean pre- and postoperative VAS-pain scores were 7.3±1.5 and 2.1±0.8, respectively (p<0.001). Conclusion
Although the primary repair technique has been successfully performed in patients with SLAP lesions over 40 years of age and high physical activity, the clinical outcomes are unsatisfactory. Biceps tenotomy improves functional and clinical results in patients with SLAP lesions who do not benefit from primary repair.
Collapse
Affiliation(s)
- Vahit Yıldız
- Adnan Menderes Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 09010 Efeler, Aydın, Türkiye.
| | | |
Collapse
|
6
|
Dougherty MC, Kulenkamp JE, Boyajian H, Koh JL, Lee MJ, Shi LL. National trends in the diagnosis and repair of SLAP lesions in the United States. J Orthop Surg (Hong Kong) 2020; 28:2309499019888552. [PMID: 31876225 DOI: 10.1177/2309499019888552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Since superior labrum anterior-to-posterior (SLAP) tear was introduced as an International Classification of Diseases-Ninth Revision, Clinical Modification diagnosis in 1994, awareness, diagnosis, and surgical treatment of this disorder has increased. Here, we aim to clarify trends in the frequency of SLAP tear diagnosis and arthroscopic SLAP repair surgery in the United States. METHODS Using private insurance claims from 2003 to 2013 in MarketScan (approximately 55 million Americans), we identified patients with SLAP tear diagnosis or arthroscopic SLAP repair surgery. Population-based rates of SLAP diagnosis and related shoulder procedures were calculated. RESULTS A total of 329,643 patients in the MarketScan database received a SLAP tear diagnosis. In all, 62.8% underwent some form of shoulder surgery after diagnosis. SLAP diagnosis increased from 28.0 per 100,000 in 2003 to 142.4 per 100,000 in 2013 (p < 0.0001); the rate of shoulder surgery in these patients increased from 20.1 per 100,000 in 2003 to 74.1 per 100,000 in 2013 (p < 0.0001). However, the percentage of patients with SLAP tears who got shoulder surgery decreased (p < 0.0001). In 2003, almost no patient got biceps tenodesis for SLAP tears; by 2013, 18.1% of surgeries for SLAP tear were biceps tenodesis. Isolated arthroscopic SLAP repairs peaked in 2009 at 28.4 per 100,000 and stabilized thereafter. CONCLUSION We confirmed prior reports that SLAP diagnosis increased from 2003 to 2013, although the percentage of these patients who underwent surgery decreased over this period. Arthroscopic SLAP repair doubled but then plateaued after 2009. Biceps tenodesis now accounts for a substantial portion of surgeries for SLAP tear. This may reflect an improved understanding of superior labrum anatomy and biomechanics.
Collapse
Affiliation(s)
- Mark C Dougherty
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - J Erik Kulenkamp
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | | | - Jason L Koh
- Department of Orthopaedic Surgery, NorthShore University Health System, NorthShore Orthopaedic Institute, Evanston, IL, USA
| | - Michael J Lee
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Lewis L Shi
- Division of Shoulder and Elbow Surgery, Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago Medicine, Chicago, IL, USA
| |
Collapse
|
7
|
Schiefer M, Cossich V, Siqueira G, Monteiro MT, Nery LF, Motta G. Intra-articular arthroscopic biceps tenodesis with interference screw: clinical and isokinetic evaluation. JSES Int 2020; 4:632-637. [PMID: 32939498 PMCID: PMC7479042 DOI: 10.1016/j.jseint.2020.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Although biceps tenodesis has been widely used to treat its pathologies, few studies looked at the objective evaluation of elbow strength after this procedure. The purpose of this study is to clinically evaluate patients submitted to long head of the biceps (LHB) tenodesis with interference screws through an intra-articular approach and analyze the results of an isokinetic test to measure elbow flexion and forearm supination strengths. Methods Patients who had biceps tenodesis were included in the study if they had a minimum follow-up of 24 months. Patients were excluded if they had concomitant irreparable cuff tears or previous or current contralateral shoulder pain or weakness. Postoperative evaluation was based on University of California-Los Angeles (UCLA) shoulder score and on measurements of elbow flexion and supination strength, using an isokinetic dynamometer. Tests were conducted in both arms, with velocity set at 60º/s with 5 concentric-concentric repetitions. Results Thirty-three patients were included and the most common concomitant diagnosis were rotator cuff tear (69%) and superior labrum anterior to posterior (SLAP) lesions (28%). The average UCLA score improved from 15.1 preoperatively to 31.9 in the final follow-up (P < .001). Isokinetic tests showed no difference in peak torque between the upper limbs. One patient had residual pain in the biceps groove. None of the patients had Popeye deformity. UCLA score and follow-up length did not demonstrate correlation with peak torque. Conclusion Arthroscopic proximal biceps tenodesis with interference screw, close to the articular margin, yielded good clinical results. Isokinetic tests revealed no difference to the contralateral side in peak torque for both supination and elbow flexion.
Collapse
Affiliation(s)
- Márcio Schiefer
- Department of Orthopaedics, Medicine School, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | - Victor Cossich
- Neuromuscular Research Laboratory, National Institute of Trauma and Orthopedics, Rio de Janeiro, Brazil.,Biomechanics Laboratory, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Gláucio Siqueira
- Department of Orthopaedics, National Institute of Trauma and Orthopedics, Rio de Janeiro, Brazil
| | - Martim Teixeira Monteiro
- Department of Orthopaedics, National Institute of Trauma and Orthopedics, Rio de Janeiro, Brazil
| | - Luiz Felipe Nery
- Department of Orthopaedics, National Institute of Trauma and Orthopedics, Rio de Janeiro, Brazil
| | - Geraldo Motta
- Department of Orthopaedics, National Institute of Trauma and Orthopedics, Rio de Janeiro, Brazil
| |
Collapse
|
8
|
Dougherty MC, Kulenkamp JE, Boyajian H, Koh JL, Lee MJ, Shi LL. Not All SLAPs Are Created Equal: A Comparison of Patients with Planned and Incidental SLAP Repair Procedures. Adv Orthop 2019; 2019:9013935. [PMID: 31781400 DOI: 10.1155/2019/9013935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/21/2019] [Indexed: 11/21/2022] Open
Abstract
Background Epidemiological studies have shown a progressive increase in the rate of superior labrum anterior-posterior (SLAP) repair surgery after the year 2000. However, it is not clear whether this is due to increased recognition of isolated SLAP tears or increased SLAP repair performed secondarily during arthroscopy for other purposes. Hypothesis/Purpose We hypothesized that both isolated SLAP repair and secondary SLAP repair increased with time and that patient age influenced the pathway to SLAP diagnosis and surgery—such that younger patients were more likely to have isolated SLAP repair surgery after being diagnosed in clinic. Study Design Descriptive epidemiology study. Methods Data were obtained from the MarketScan database from 2003 to 2013. CPT and ICD-9 codes were used to identify SLAP surgery patients and concomitant procedures. The timing of SLAP diagnosis relative to surgery was used to determine whether the injury was recognized preoperatively. Results 64,497 SLAP surgery patients were included. Preoperative SLAP diagnosis increased from 17.1% in 2003 to 44.6% in 2013. Patients diagnosed preoperatively were younger and had fewer concomitant procedures. Increasing age and concomitant rotator cuff tear (RCT) repair corresponded to lower odds of preoperative SLAP diagnosis. Discussion Younger patients were more likely to have their SLAP tear diagnosed prior to surgery. Those diagnosed before surgery had fewer simultaneous procedures during their operations, suggesting that SLAP repair was more likely the primary operation. From 2003 to 2013, SLAP tears were increasingly recognized in the preoperative setting.
Collapse
|
9
|
Alali A, Li D, Monteiro S, Choudur H. Feasibility of high resolution ultrasound for SLAP tears of the shoulder compared to MR arthrogram. BJR Open 2019; 1:20190007. [PMID: 33178939 PMCID: PMC7592471 DOI: 10.1259/bjro.20190007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 05/25/2019] [Accepted: 06/01/2019] [Indexed: 12/11/2022] Open
Abstract
Objectives: The purpose of this prospective pilot study was to evaluate the feasibility and accuracy of high resolution ultrasound in the detection of superior labral anteroposterior (SLAP) tears of the shoulder compared to MR arthrogram. Methods and materials: 48 adult patients were included in the study. All patients had high resolution ultrasound of the superior labrum and biceps labral anchor prior to MR arthrogram. Ultrasound and MR arthrograms were evaluated separately for the presence or absence of SLAP tear using the same grading. The presence or absence of a tear and grading of the tears on MR arthrograms and ultrasound were compared and evaluated using κ statistics. Results: Both MRI and ultrasound demonstrated a SLAP tear in 27 of the 48 patients. MRI and ultrasound were in agreement on the absence of a tear in 19 patients. There was a disagreement between MRI and ultrasound in 2 of the 48 patients regarding the existence of a tear. The two modalities demonstrated substantial agreement on the presence or absence of a tear ( κ = 91.4 %, p < 0.001) as well as the grading of the tear ( κ = 84.4 %, p < 0.001). Conclusions: In this pilot study, the feasibility and accuracy of high resolution ultrasound for SLAP tears were evaluated and compared with MR arthrogram. MRI and ultrasound demonstrated substantial agreement on the presence or absence of SLAP tears and grading of the tears. Advances in knowledge: This pilot study explores and supports the use of ultrasound as a screening tool for SLAP tears, especially as it is readily available, fast and inexpensive.
Collapse
Affiliation(s)
- Akeel Alali
- Department of Radiology, McMaster University, Hamilton, Canada
| | - David Li
- Department of Radiology, McMaster University, Hamilton, Canada
| | - Sandra Monteiro
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Hema Choudur
- Department of Radiology, McMaster University, Hamilton, Canada
| |
Collapse
|
10
|
Abstract
Background: The surgical treatment of a Superior Labrum Anterior and Posterior (SLAP) lesion becomes more and more frequent as the surgical techniques, the implants and the postoperative rehabilitation of the patient are improved and provide in most cases an excellent outcome. Objective: However, a standard therapy of SLAP lesions in the shoulder surgery has not been established yet. An algorithm on how to treat SLAP lesions according to their type and data on the factors that influence the surgical outcome is essential for the everyday clinical practice. Method: In this article, a retrospective evaluation of patients with SLAP lesion, treated surgically in our orthopaedic clinic was conducted. Results: According to the clinical outcome and our experience with the surgical therapy of SLAP lesions we demonstrate an algorithm on the proper therapeutic approach. Conclusion: SLAP I lesions are treated with debridement. Most controversies concern patients with SLAP II lesions, whose therapy is either fixation of the superior labrum or tenotomy/tenodesis of the long head of the biceps tendon. For patients with SLAP III or IV lesions the most commonly accepted approach is tenotomy or tenodesis of the long head of biceps tendon.
Collapse
|
11
|
Aydin N, Unal MB, Asansu M, Tok O. Concomitant SLAP repair does not influence the surgical outcome for arthroscopic Bankart repair of traumatic shoulder dislocations. J Orthop Surg (Hong Kong) 2018; 25:2309499017718952. [PMID: 28675978 DOI: 10.1177/2309499017718952] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Prior studies revealed the presence of superior labrum anterior-to-posterior (SLAP) injury together with Bankart lesions in some patients. The purpose of the study is to compare the clinical results of isolated Bankart repairs with the clinical results of Bankart repairs when performed with concomitant SLAP repairs. METHODS The patients who underwent arthroscopic surgery for treatment of anterior glenohumeral instability were evaluated retrospectively. Group 1 consisted of 19 patients who had arthroscopic SLAP repair together with Bankart repair. The mean age of the patients was 23. Group 2 consisted of 38 patients who underwent isolated Bankart repair. The mean age was 24. Knotless anchors were used in both groups. RESULTS The mean follow-up was 34 months (range: 26-72). In group 1, the mean preoperative Constant score was 84 (range: 74-90, standard deviation (SD): 5.91) and Rowe score was 64.1 (range: 40-70, SD: 8.14). In group 2, the preoperative Constant score was 84.4 (range: 70-96, SD: 5.88) and Rowe score was 60 (range: 45-70, SD: 7.95). In group 1, the postoperative mean Constant score raised to 96.8 (range: 88-100, SD: 2.91) and the mean Rowe score raised to 92.3 (range: 85-100, SD: 5.17). In group 2, the postoperative mean Constant score was 94.9 (range: 88-100, SD: 3.70) and the mean Rowe score was 94.2 (range: 80-100, SD: 4.71). The difference between the scores of two groups was insignificant ( p > 0.05). When the numbers of redislocations and range of motion were compared, no significant difference was found ( p > 0.05). CONCLUSION Accompanying SLAP repair in surgical treatment with Bankart repair for shoulder instability does not affect the results negatively. Properly repaired labral tears extending from anterior inferior to the posterior superior of the glenoid in instability treatment have the same outcome in overall results as repaired isolated Bankart lesions.
Collapse
Affiliation(s)
- Nuri Aydin
- 1 Department of Orthopedics and Traumatology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | - Mehmet Bekir Unal
- 2 Department of Orthopedics and Traumatology, Marmara University, Istanbul, Turkey
| | - Mustafa Asansu
- 3 Department of Orthopedics and Traumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Okan Tok
- 4 Department of Orthopedics and Traumatology, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
| |
Collapse
|
12
|
Ogura A, Morihara T, Fujiwara H, Arai Y, Kida Y, Ito H, Furukawa R, Kabuto Y, Sukenari T, Kubo T. Validity of radial magnetic resonance imaging to determine the extent of Bankart lesions. Clin Imaging 2018; 48:131-8. [DOI: 10.1016/j.clinimag.2017.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 09/21/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
|
13
|
Ataoglu MB, Cetinkaya M, Ozer M, Ayanoglu T, Kanatli U. The high frequency of superior labrum, biceps tendon, and superior rotator cuff pathologies in patients with subscapularis tears: A cohort study. J Orthop Sci 2018; 23:304-309. [PMID: 29153993 DOI: 10.1016/j.jos.2017.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 09/14/2017] [Accepted: 10/24/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND The purpose of this study was to assess the frequency of superior labrum anterior posterior (SLAP) lesions, long head of biceps tendon (LHBT) pathologies, and superior rotator cuff tears accompanying subscapularis tears. We hypothesised that LHBT lesions, superior rotator cuff tears, and especially SLAP lesions were very frequent with subscapularis tears. METHODS The digital files of patients who underwent shoulder arthroscopy were reviewed retrospectively. One hundred and eleven patients with subscapularis tears evident on surgery videos were examined. Superior labrum, LHBT, and superior rotator cuff lesions were investigated by the authors of this study. The statistical analyses were made with SPSS statistics software, and significance was set at P < 0.05 value. RESULTS There were 111 patients with both subscapularis tears and surgery videos. The mean age was 58.09 ± 10.21, and 63.1% of the patients were female. 98.2% of the 111 patients had a SLAP lesion. 7.2% of those were SLAP I and 91% were SLAP II lesions while 1.8% were healthy. The 75.7% of the patients had a LHBT pathology, and 83.8% had superior cuff tear. CONCLUSIONS Subscapularis tears were almost always accompanied by SLAP lesions. On the other hand, biceps tendon pathologies and superior rotator cuff tears were also very frequent with subscapularis tears. LEVEL OF EVIDENCE Prognostic study, Level IV (retrospective cohort study).
Collapse
Affiliation(s)
| | - Mehmet Cetinkaya
- Erzincan University Mengucek Gazi Training and Research Hospital, Department of Orthopaedics & Traumatology, Erzincan, Turkey.
| | - Mustafa Ozer
- Necmettin Erbakan University Meram Medical School, Department of Orthopaedics & Traumatology, Konya, Turkey
| | - Tacettin Ayanoglu
- Gazi University School of Medicine, Department of Orthopaedics & Traumatology, Ankara, Turkey
| | - Ulunay Kanatli
- Gazi University School of Medicine, Department of Orthopaedics & Traumatology, Ankara, Turkey
| |
Collapse
|
14
|
Abstract
Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of clinical and functional outcomes to the point that arthroscopic treatment is considered nowadays the standard of care.
Collapse
Affiliation(s)
- Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| | - Vasilios Raoulis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece
| |
Collapse
|
15
|
Hsiao M, Hung C, Chang K, Özçakar L. Dynamic Ultrasonography of the Intra-Articular Long Head Biceps Tendon and Superior Labrum. Am J Phys Med Rehabil 2016; 95:e183-4. [DOI: 10.1097/phm.0000000000000528] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
16
|
Hölscher T, Weber T, Lazarev I, Englert C, Dendorfer S. Influence of rotator cuff tears on glenohumeral stability during abduction tasks. J Orthop Res 2016; 34:1628-35. [PMID: 26756861 DOI: 10.1002/jor.23161] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/04/2016] [Indexed: 02/04/2023]
Abstract
One of the main goals in reconstructing rotator cuff tears is the restoration of glenohumeral joint stability, which is subsequently of utmost importance in order to prevent degenerative damage such as superior labral anterior posterior (SLAP) lesion, arthrosis, and malfunction. The goal of the current study was to facilitate musculoskeletal models in order to estimate glenohumeral instability introduced by muscle weakness due to cuff lesions. Inverse dynamics simulations were used to compute joint reaction forces for several static abduction tasks with different muscle weakness. Results were compared with the existing literature in order to ensure the model validity. Further arm positions taken from activities of daily living, requiring the rotator cuff muscles were modeled and their contribution to joint kinetics computed. Weakness of the superior rotator cuff muscles (supraspinatus; infraspinatus) leads to a deviation of the joint reaction force to the cranial dorsal rim of the glenoid. Massive rotator cuff defects showed higher potential for glenohumeral instability in contrast to single muscle ruptures. The teres minor muscle seems to substitute lost joint torque during several simulated muscle tears to maintain joint stability. Joint instability increases with cuff tear size. Weakness of the upper part of the rotator cuff leads to a joint reaction force closer to the upper glenoid rim. This indicates the comorbidity of cuff tears with SLAP lesions. The teres minor is crucial for maintaining joint stability in case of massive cuff defects and should be uprated in clinical decision-making. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1628-1635, 2016.
Collapse
Affiliation(s)
- Thomas Hölscher
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Tim Weber
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Igor Lazarev
- Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
| | | | - Sebastian Dendorfer
- Laboratory for Biomechanics, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany.,Regensburg Center of Biomedical Engineering, OTH and University Regensburg, Regensburg, Germany
| |
Collapse
|
17
|
|
18
|
Castagna A, De Giorgi S, Garofalo R, Tafuri S, Conti M, Moretti B. A new anatomic technique for type II SLAP lesions repair. Knee Surg Sports Traumatol Arthrosc 2016; 24:456-63. [PMID: 25413594 DOI: 10.1007/s00167-014-3440-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 11/11/2014] [Indexed: 12/15/2022]
Abstract
PURPOSE A new and more anatomical technique for SLAP II lesions repair is described. It consists in the reattachment of the medial aspect of the biceps anchor to the superior glenoid neck with a mattress stitch posterior and medial to the biceps anchor and a simple stitch placed anteriorly to the biceps. METHODS From 2011 to 2012, 14 patients matching the inclusion criteria were selected for the study. A visual analogic scale, ROWE, UCLA, ASES and Constant scores were used to make evaluation. The passive ROM before surgery, at final follow-up, and the resumption of sports activities were analysed. RESULTS The Constant, ASES, UCLA and ROWE scores passed from 64.6 (SD 13.9), 76.9 (SD 22.4), 28.4 (SD 23.8) and 53.6 (SD 20.6) to, respectively, 92.6 (SD 11.8), 108.3 (SD 8.5), 33.6 (SD 2.7) and 96.5 (SD 7.2) at final follow-up. Of the four patients who had participated in agonistic overhead athletics preoperatively, all of them were able to return to their preinjury level. No complications were observed in the present study. CONCLUSION In our technique, the anatomy is respected leaving the articular aspect of the superior labrum loose and reinforcing the medial side. The clinical relevance of this work is that probably this technique could improve clinical results, giving a better mobility of the shoulder and a return to the same preoperative level in overhead athletes.
Collapse
|
19
|
Blanchette MA, Pham AT, Grenier JM. Conservative treatment of a rock climber with a SLAP lesion: a case report. J Can Chiropr Assoc 2015; 59:238-244. [PMID: 26500357 PMCID: PMC4593038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This case report describes the clinical presentation and conservative treatment of a patient who suffered from a superior labrum anteroposterior (SLAP) tear of the shoulder after a rock climbing session. The 26 year old man had injured his right shoulder while trying to reach a distant socket with his shoulder 90° abducted and in extreme external rotation. After initial treatment failure in chiropractic, the patient sought an orthopaedist and physiotherapy care. A contrast magnetic resonance examination revealed a SLAP lesion. Awaiting orthopaedic consultation and in the absence of clinical improvement the patient sought care from a second chiropractor. Clinical examination revealed a mild winging of the right scapula and the presence of trigger points in the rotator cuff muscles, biceps, rhomboids and serratus anterior. The chiropractic treatment then included soft tissue mobilization and the prescription of strengthening exercises of the serratus anterior and rotator cuff muscles. After 4 sessions, the patient did not feel any pain and gradually resumed all his recreational activities. Clinicians should be aware that SLAP lesions are difficult to identify clinically and that manual therapy might be an important component of conservative treatment of SLAP lesions.
Collapse
Affiliation(s)
- Marc-André Blanchette
- Public Health PhD Program, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Ai-Thu Pham
- Private practice, Momentum Chiropratique, Vaudreuil-Dorion, QC, Canada
| | - Julie-Marthe Grenier
- Associate Professor, Department of Chiropractic, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| |
Collapse
|